| NPI | 1336539881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0001274) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP014758) |
| 363LF0000X Nurse Practitioner, Family (Licence: DE AN0013774) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 12297) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2023-11-20 |